PHNOM PENH (Khmer Times) – As a boy, Tho Vantha scavenged the trash piles of Phnom Penh so that his family wouldn’t go to bed hungry. Now, he’s one-and-a-half years away from becoming one of the first home-trained Cambodian neurosurgeons.
At present, the country of 15 million has only 24 neurosurgeons – one per 870,000 people – almost all practicing in Phnom Penh. They were all trained overseas, but they are training the next generation right here in Cambodia. Eight residents, including Mr. Tho, are on their way to join their ranks.
“I’ve wanted to be a doctor since I was six,” said Mr. Tho, 28. “I wanted to save my family if they ever got injured or sick.”
As the name suggests, neurosurgery prevents, diagnoses and treats disorders that hit the nervous system, which may come from trauma or diseases.
The residents in the current program began their medical training at the government-funded University of Health Sciences. Many of them came from humble beginnings. They may be the first neurosurgeons to set up practices in the countryside, where people need them most.
A Hard Past
Mr. Tho came from Kampot, the eldest of three children. His mother farmed and his father worked in construction in Vietnam. When Mr. Tho turned 11, his father found another woman abroad and did not return.
The family had to sell their home and move to Phnom Penh, where his mother sold vegetables and Mr. Tho went to school during the day then scavenged in the evening. They didn’t get to eat some evenings, he said. To save money, he stayed at a home for the poor, run by the organization Pour un Sourire d’Enfant (PSE). He lived like this for five years.
Despite the challenges, Mr. Tho got a stipend from Japanese donors by becoming the top-scoring student at the orphanage out of a population of thousands. When some visiting French doctors stopped by the orphanage, they met Mr. Tho and became impressed. They pledged to support his medical school tuition through PSE if he got in.
One of Mr. Tho’s university mentors encouraged him to specialize in neurosurgery – only Mr. Tho and one other student from his class cohort got into the residency program.
To help pay the annual $1,500 fee and living expenses for himself and his family, he got a part-time job as a doctor’s assistant and received $200 per month from the Neurosurgery Resident Scholarship Program established by the World Federation of Neurosurgery Societies Foundation. Despite living on several dollars per day, he persevered into his third year.
“When I graduate, I don’t think I’ll stay in Phnom Penh,” he said. “I’ll go to Battambang or Kampong Cham to practice there.”
The Needs of the Country
The recent head trauma of Princess Ouk Phalla, who was rushed to Calmette Hospital, underlines the critical need for neurosurgery in the country. Cambodia is awash with direct physical damage.
“The trauma is tremendous,” said Dr. John Atwater, a visiting American doctor. “There are many traffic accidents, with construction workers getting injured and also those engaged in agriculture work. There are many mopeds and pedestrians getting hit.”
Poor public health leads to many tuberculosis cases, wreaking havoc on people’s central nervous systems. Tumors and deformities add to the damage.
“Every month the number of patients is increasing,” said Iv Vycheth MD, president of the Cambodian Society of Neurosurgeons.
Lack of Access
Despite the great need for neurosurgery, most Cambodians will not be able to access it. One reason is the lack of health centers – getting to Phnom Penh can be a logistical nightmare. Even if patients can get to Phnom Penh to receive help, sometimes they can’t do so on a timely enough basis.
“From the standpoint of doctor training, the skill level of physicians here is very, very high,” said Dr. Atwater. “And it’s not the quality of treatment but access to treatment.”
Cambodia currently has six hospitals that offer neurosurgery: Preah Kossamak Hospital, Preah Kettomealea Hospital, Calmette Hospital, Khmero-sovietique Hospital and Kantha Bopha Children’s Hospital in Phnom Penh and Siem Reap. A few services are offered for children in the National Pediatric Hospital.
There are almost no services in the provinces except in Battambang, where one surgeon is undergoing neurological training to expand his range of skills.
Cambodia also lacks expensive medical equipment – there are few MRI machines and not enough CT scanners to go round. Starved of modern tools, surgeons have to rely on older techniques to repair people.
However, foreign support is starting to pick up, with doctors coming from the US, Japan, Korea and France to help out and share the latest techniques.
Last month, medical students at Preah Kossamak Hospital got to watch a live surgery on a young boy’s spine, performed by Korean-American surgeon Dr. Kee Park, who is helping to expand and develop the residency program.
“We want to unify and help relieve some of this shortage,” said Dr. Vycheth, “but we can’t be working alone.”